Late-onset hyperlactataemia following paediatric cardiac surgery.
OBJECTIVE
To investigate the clinical significance of a late rise in blood lactate concentration, developing after PICU admission, in older children undergoing cardiac surgery.


METHODS
Retrospective, observational study.


METHODS
Single UK PICU.


METHODS
A total of 147 children, aged 2-16 years, in 2 cohorts: FONTAN (n = 63) Fontan operation; and MIXED (n = 84) operations of varying complexity.


METHODS
None.


RESULTS
Sequential data were collected up to 12 h postoperatively: arterial blood gas, lactate, glucose concentrations; haemodynamic variables; inotropic support; urine output, core-peripheral temperature gradient. Data were collected on clinical outcomes: PICU mortality; length of ventilation, PICU stay; renal and hepatic function. Late-onset hyperlactataemia (LOH) was defined if blood lactate increased to or above 3 mmol/l. Data from the LOH group were compared to a group with a low blood lactate (<3 mmol/l) throughout (No_LOH). LOH occurred in 28 (44%) and 21 (25%) of patients in FONTAN and MIXED cohorts, respectively. A strong association was found between LOH and hyperglycaemia (P < 0.001). No significant difference was found in postoperative urine output, core-peripheral temperature gradient or inotrope requirement in the LOH versus No_LOH groups. No significant differences were found with respect to clinical outcomes in the LOH versus No_LOH groups. All LOH patients were discharged from PICU within 1 day and survived.


CONCLUSIONS
LOH is common in older children following cardiac surgery. We found no evidence to suggest that it is associated with adverse clinical outcomes. The strong association between LOH and hyperglycaemia supports a metabolic aetiology.
Jackman
Lara
L
Paediatric Intensive Care Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
Shetty
Nayan
N
Davies
Paul
P
Morris
Kevin P
KP
D000140:Acidosis, Lactic / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D000293:Adolescent; D001784:Blood Gas Analysis; D001786:Blood Glucose / Q000032:analysis; D001831:Body Temperature / Q000502:physiology; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies
D001786:Blood Glucose